The description of care trusts as either the ‘vanguard’ of integrated organisations or a ‘lost tribe’ was made by the former Chief Executive of a care trust at an HSMC learning event soon after their creation. It nicely captures the mixed views of care trusts as either the cutting edge of integration between health and social care or as a band of individuals and organisations that have happened upon a clumsy structural solution as a way of shielding themselves from other agendas.